Transcript 1. Integration of Ep..

Dr. Zhen XU
Branch of Respiratory Disease Prevention and Control
Division for Disease Control and Emergency Response
Chinese Center for Disease Control and Prevention
June, 2011
ILI surveillance in outpatients of sentinel hospitals
• 556 sentinel hospitals, 411 labs
SARI surveillance in inpatients
• Sentinel-based: 10 hospitals
• Population-based: Jingzhou city in Middle China
ILI/ARI outbreak report
• Events reporting, virus detection
National notifiable communicable disease reporting
• H5N1, pdm H1N1: Class B; seasonal flu: Class C
• No virological info
Etiology-unknown pneumonia surveillance

Integration of ILI sentinel surveillance
system and ILI outbreak event report
system

Data input, query and auto analysis

Lab info management

Surveillance quality monitoring

Epidemiology Surveillance
Diagnosis and Registry: daily
Reporting of ILI case: weekly
Collect and analyze the surveillance data

Laboratory Surveillance
Specimen collection: 5-15 nose ＆ throat swabs from
ILI cases per week per hospital
Lab detection: PCR test or virus isolation, antigenic
and genetic analysis, antiviral resistance
5
ILI surveillance information reporting
ILI reporting
ILI sentinel hospitals
Specimens collection
Send specimens to labs
Network laboratories
Specimens
info & results
Detection
Isolates to CCDC
Reidentification
CCDC
 Input data of ILI counts and ILI% by week
and age group;
 Data query by date, by week, by age group,
by hospital and by area ;
 Input data of PCR and virus isolation results
by specimen within 48h;
 Data query by patient, by date, by week, by
hospital and by area ;
 event-based report
 basic info of ILI outbreak: major symptoms, case number,
lab results, duration and location of the outbreak
 progress report of outbreak response;
ILI analysis
300
10
250 暴
8
发 6
200 起 4
数
2
报
告
暴
发 150
疫
情 100
起
数 50
Surveillance quality
monitoring
4000
Virus typing
阳
性 3500
甲型H1N1流感暴发疫情
数
3000
无实验室结果的ILI暴发疫情
2500
Untyped
Yamagata
Victoria
B(lineage not determined)
A(unsubtyped)
A(unsubtyped excluded H1N1pdm)
H1N1
H3N2
H1N1pdm
Influenza Positive(%)
季节性流感暴发疫情
70
阳
60 性
50
率
（
%
）
40
2000
0
14 19 24 29 34 39 44 49 2 7 12 17
周次
2010-2011
30
1500
20
1000
10
500
0
周次
15 21 27 33 39 45 51 4 10 16 22 28 34 40 46 52 5 11 17 23 29 35 410 47 1 7 13 19
2008-2009
2009-2010
0
14 21 28 35 42 49
2010-2011
2009
3
10 17 24 31 38 45 52
2010
7
14 21 28 35 42 49
2011
周次
environment
surveillance data
Serological
surveillance data
Information dissemination: Weekly Report
Influenza
Weekly Report
www.cnic.org.cn/eng
www.cnic.org.cn
Information Sharing
FluID




To monitor the severity of Pandemic H1N1 and
understand the characteristics of SARI cases caused
by pdm H1N1
Following WHO case definition
Support by MOH and EID program
Data source:
◦ Epi data by case: Respiratory, Internal ICU, and Infectious
Departments from 10 hospitals
◦ Lab data: 10 network Labs where the hospitals located


Data report: EPI Database weekly sent from hospitals
and labs by email
Data sharing: Brief report sent to hospitals and labs
regularly
•Most are
clinical cases;
•No virological
info;
•Limited use for
flu surveillance
Case patients hospitalized with 2009 pandemic
influenza A (H1N1) virus infection, by date of
onset, China, Sep 2009–Feb 2010. ICU,

Still lack of a comprehensive surveillance system to oversee
the virus and diseases caused by flu virus
◦ Characteristics and burden of mild, severe and fatal case


Maintain the current giant ILI network—cost, willingness and
enthusiasm
Translating data into practice is much more important than
collecting data
◦ Surveillance data, research data



Risk assessment of surveillance data
Quality monitoring didn’t followed by in time quality
improvement action
SARI surveillance info is independent from ILI system. Mild
and severe case caused by flu virus cannot be linked well

Vaccine gap
◦ Supply: 30m doses VS 570m population
◦ Capacity: 126m doses VS 570m population

Vaccination strategy
◦ Annual technical recommendations for target population only
◦ Flu vaccination not covered by national government or
medical insurance
◦ Beijing is the only city to provide the free vaccination service
to local population: ﹥65yrs, primary and middle school
students

Improve the sentinel SARI surveillance
◦ Internet-based reporting of epi and lab data
◦ Integration with HIS and LIS in hospitals
◦ Publication and sharing of SARI findings



Modeling the ILI seasonal pattern
Application of early warning based on long-term
and good-quality flu data in pilot areas
Describe the burden of severe and fatal cases
caused by flu virus
◦ Population-based inpatients surveillance
◦ DSP site: ICD code-based deaths analysis
Use the data for vaccination policy making
Integrated information system
Submission
Data Entry
Search
Download
Sequence
Database
Surveillance
Information
System
Result feedback
Analysis&Report
Share
Information
Platform
Security check
Receipt
Take&Return
Lab Data
Management
Website
Public propaganda
Technical support
Result Entry
New
Security check